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What is the best treatment target in axial spondyloarthritis: tumour necrosis factor α, interleukin 17, or both?
Denis Poddubnyy1,2, Joachim Sieper1
1Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Germany.
Abstract:
After about 15 years of experience with the TNF blockers as the only effective drugs in axial spondyloarthritis patients who fail conventional treatment, for the first time we see now that another targeted therapy, the inhibition of IL-17, is also effective. By indirect comparison of the treatment effect between the two types of drugs, efficacy seems to be on a similar level. This raises quite a few important questions that are related to both pathogenesis and treatment strategies for which the answers are currently largely unknown, but would be of great relevance for optimizing therapies. In this article, we discuss these questions and ways in which such questions could be answered.
Insights
Tumor necrosis factor (TNF) blockers and interleukin-17 (IL-17) inhibitors show similar efficacy in treating axial spondyloarthritis. This finding opens new avenues for optimizing treatment strategies and understanding disease pathogenesis.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Tumor necrosis factor (TNF) inhibitors have been the primary targeted therapy for axial spondyloarthritis (axSpA) refractory to conventional treatments for over 15 years.
- The emergence of interleukin-17 (IL-17) inhibitors provides a new therapeutic option for these patients.
Purpose of the Study:
- To compare the efficacy of IL-17 inhibitors with established TNF blockers in axial spondyloarthritis.
- To explore the implications of these findings for disease pathogenesis and future treatment strategies.
Main Methods:
- Indirect comparison of treatment effects between TNF inhibitors and IL-17 inhibitors based on existing clinical trial data.
- Review and discussion of current understanding of axSpA pathogenesis.
Main Results:
- IL-17 inhibition demonstrates comparable efficacy to TNF blockers in axial spondyloarthritis patients.
- Efficacy appears to be on a similar level between the two drug classes through indirect comparisons.
Conclusions:
- IL-17 inhibitors represent a significant advancement in treating axial spondyloarthritis, offering an alternative to TNF blockers.
- Further research is needed to address key questions regarding pathogenesis and to optimize therapeutic approaches for axSpA.